Implantable fluid movement device

ABSTRACT

An implantable fluid movement device is provided. The device is adapted to move body fluid from one part of the body of a patient to another part of the body and further adapted to secure the a tube end of the fluid movement device to a location inside a treated patient.

TECHNICAL FIELD

The present invention relates to a method and a device for moving afluid within the body.

BACKGROUND

Body fluid drains are used at so-called drainage sites for drainingfluids from cavities in a patient's body, typically during and aftersurgical procedures. The drainage site may be a natural body cavity ororifice or may be surgically formed.

The drain device used for draining fluid from the body typicallycomprises a tube extending from the treatment area within the bodythrough the skin of the patient and ending in a manual pump locatedoutside the body. The pump is associated with a reservoir for storingthe drained fluid. The reservoir is then emptied at suitable timeintervals by manually compressing the reservoir.

A drain can be required for shorter or longer periods of time dependingon the condition for which the drain is used. In particular when thedrain is used for a longer period of time the drains existing today arecumbersome to use and impractical for the patient who is required tomove the drain with him/her when moving around.

Fluid can also be moved within the body in a hydraulic treatment system,wherein the fluid is hydraulic treatment fluid instead of a body fluid,delivered from the treatment area, which in this case may be a reservoiradapted to hold hydraulic treatment fluid.

Also, U.S. Pat. No. 7,195,608 describes a drainage device for movingfluid to the urine bladder.

The drainage device described in U.S. Pat. No. 7,195,608 describes anelement for securing an end of the drainage device to the urine bladder.However, securing element suffers from a number of potential drawbacks.In particular there is a risk that the securing element does not providea tight and lasting sealing whereby there is a risk that drained fluidends up outside the urine bladder, which of course is undesired.

Hence, there exists a need for a drain that is less cumbersome to useand which enables a patient to more easily move around while still beingattached to the drain. There is also a need for an efficient securingelement that enables a tight and secure sealing for a drainage device.

SUMMARY

It is an object of the present invention to overcome or at least reducesome of the problems associated existing fluid movement devices, such asdrainage devices or hydraulic treatment devices.

It is another object of the present invention to provide a fluidmovement device that enables a patient to more easily move around whilestill being attached to the drain.

It is yet another object to provide a fluid movement device that can beefficiently secured.

At least one of the above objects is obtained by the method, apparatus,device and system as set out in the appended claims. Thus, by providingan implantable drain adapted to move body fluid or a hydraulic reservoirwith hydraulic treatment fluid to move hydraulic fluid, from one part ofthe body to another part of the body, a fluid movement device that whichis completely implanted and which does not have any mechanical structurepenetrating through the skin of the patient is obtained.

The apparatus for drainage of a body fluid or movement of hydraulictreatment fluid in a human or mammal patient in accordance with thepresent invention comprises a fluid movement device for pumpinghydraulic treatment fluid or body fluid. The fluid movement device ispowered by an energy source and may be powered by any suitable meanssuch as an electrical or a hydraulic motor. At least one connecting tubeis connected to the fluid movement device so that the fluid movementdevice and the tube form a drainage or hydraulic arrangement. Thearrangement is adapted to be implanted inside the body of the patient,and placed so that the tube interconnects one part of the body withanother part of the body and where fluid movement device is adapted tosuck body fluid from the one part of the body via the tube to the otherpart of the body. Hereby an implantable fluid movement device isobtained which can pump body or hydraulic fluid from a treatment area toanother part of the body where the fluid can be absorbed or transportedout from the body in a normal way.

The implantable fluid movement device in accordance with the presentinvention can be used to move body fluid between different parts of thebody depending on the type of body fluid being drained. For example andwithout limitation the fluid movement device can be adapted to drainurine from the urine accumulating renal part of the kidney, and movingthe urine via at least one tube to the urine bladder. The fluid movementdevice can also be adapted to drain liquid from the hydrocephalus in thebrain area, and moving it to the abdomen. The fluid movement device canalso be adapted to drain liquid from ascites in the abdomen, and movingit to the lymphatic system of the body or to the urine bladder. Also,the fluid movement device can also be adapted to drain liquid from thethoraxial cavity, and moving the liquid to the abdomen.

Depending on the type of treatment and where the body fluid is suckedfrom and to where in the body the fluid is delivered the tubes used maybe shaped to suit the particular treatment.

In accordance with one embodiment a method of securing a connecting tubefor use in an implantable device is provided. The tube is adapted tomove body fluid from one part of the body, via the at least oneconnecting tube to another part of the body, the connecting tube havinga distal end adapted to be located in the bladder of the human or mammalpatient for drainage of a body fluid or hydraulic treatment fluid from atreatment area of the human or mammal patient into the bladder, themethod comprising the steps of:

-   -   opening a hole in the bladder,    -   placing the end of the tube in the bladder.    -   securing the tube on the outside of the bladder by invaginating        the tube using sutures or staples, thus creating a tunnel around        the tube, wherein said tube comprising a net material secured to        said tube, in the part of the tube end at a distance from said        tube end, the further method comprising,

placing the net material in connection to the opening of the invaginatedtunnel, and securing the net material to the outside of the bladder.

The bladder can be the urine bladder or the peritoneum. The same methodcan also be used for securely fastening a tube into other organs.

In accordance with one embodiment a tube adapted to be inserted in aluminal or bladder organ of a patient, said tube adapted to enter saidorgan in a tube passageway. The tube comprises a combined securing andsealing device adapted for long term closing of the tube passageway andfor long term securing the tube onto an organ. The combined securing andsealing device can comprise a patch comprising a net mounted onto thetube. The net can be adapted to a seal of overgrowth of human fibrotictissue over the whole net and the patched part of said organ, therebycompletely sealing said net and attaching said net to said organ, thussealing around said tubular passageway. In accordance with oneembodiment a net structure is provide with openings less than 2.5 mm,preferable 0.5 mm, to allow said tissue overgrowth.

A specific embodiment of a hydraulic treatment system is presentedbelow.

Ione embodiment an apparatus for treating urinary retention of a patientby discharging urine from the urinary bladder, comprising an expandablemember adapted to be implanted inside the urinary bladder of thepatient, and an implantable control device for controlling the volume ofthe expandable member, the control device being adapted to be connectedto the expandable member through the wall of the urinary bladder isprovided. As a result of the expansion of the expandable member urine isdischarged from urinary bladder through the urethra.

The expandable member is preferably releasably attached to the controldevice with quick coupling, such as snap-lock fitting or the similar andfurther member is designed with a capacity to assume a shape whichadmits its transportation through urethra. The expandable member cancomprise a bellow or a similar structure undergoing controlled expansionand collapse.

Further, the expandable member is hydraulically controlled and comprisesa cavity for hydraulic fluid and the control device comprises areservoir for hydraulic fluid. The expandable member and the controldevice are accordingly adapted to be hydraulically connected through thewall of urinary bladder. For this purpose, the control device preferablycomprises a tube to establish hydraulic connection and for transportingthe hydraulic fluid between the reservoir and the cavity.

The control device of the apparatus can comprises an operation devicefor transporting hydraulic fluid to and from the cavity and thereservoir. In one mode of operation, the expandable member is adapted tobe emptied by the pressure exerted by urine of the urinary bladder totransport the hydraulic fluid from the cavity to the reservoir. Theoperation device is capable of transporting hydraulic fluid to cavity ofthe expandable member to obtain a suitable urinary pressure fordischarging urine. Also a urinary pressure of at least 50 cm waterpressure for discharging urine can be provided.

The operation device can be powered, In one embodiment the operationdevice is a powered pump. Further, the operation device can comprise orbeing connected to an injection port, to calibrate the amount ofhydraulic fluid. The operation device can also be manually operated byan injection port which is operated from outside the body by filling oremptying said injection port.

In addition the apparatus can comprise implantable restriction devicesadapted to close the ureters when discharging urine from the urinarybladder in order to prevent any urinary backflow towards the kidneys.Preferably, these restriction devices open and close by the activity ofthe operation device.

The apparatus can also comprise a restriction device adapted to open andclose the urethra to assist patients having an impaired urinarysphincter function.

The control device can further comprise a control assembly adapted to beimplanted subcutaneously or in the abdominal cavity in the patient forconnection to other parts of the control device. The control assemblycomprises a source of energy for powering the operation device and otherenergy consuming parts of the control device. These parts are furtherdescribed in the context of the system according to invention comprisingthe recited apparatus. The control assembly can further comprise aninjection port for receiving hydraulic fluid, connected to thereservoir.

The apparatus can also comprise an implantable pressure sensor formeasuring the urinary pressure in the urinary bladder direct orindirect, such as measuring the pressure inside the implantable member.

The hydraulic fluid can comprise an agent for counteracting microbialgrowth, such as an antibiotic.

In order to further assist urinary discharge, the control device canfurther comprise an implantable device for electrically stimulatingmuscles of the urinary bladder to contract the same, to co-operate withthe expandable member to discharge urine from the urine bladder.

Also, the electrically stimulating device can comprise a plurality ofelectrode strips attached to muscles of the urinary bladder. In analternative, the apparatus can comprise a second hydraulic connectionbetween the expandable member and the reservoir. The second connectionis dimensioned so that the pumps pumping volume capacity is clearly muchlarger than the emptying capacity of said second connection, when open.According to this alternative arrangement, the expandable member isadapted to be emptied by the pressure exerted by urine of the urinarybladder to transport the hydraulic fluid from the cavity to thereservoir by said second connection.

The present invention also relates to a method implanting the describedapparatus, which comprises inserting a needle-like tube into the abdomenof the patient; filling the abdomen with gas through said tube, therebyexpanding the abdominal cavity; placing at least two laparoscopictrocars in the patient's body and inserting a camera through one of saidtrocars into the abdomen; inserting at least one dissecting tool througha trocar and dissecting an area of at least one portion of the urinarybladder of patient; incising an opening in the urinary bladder wall;placing an expandable member inside the urinary bladder; placing acontrol device outside the urinary bladder; and interconnecting theexpandable member and the control device with an interconnection device.The method also comprises tunnelling by suturing the urinary bladderwall to itself in order to immobilize the interconnecting device inposition penetrating the urinary bladder wall while establishing ahydraulic connection between a cavity of the expandable member and areservoir of the control device. Further, the method comprises placingnet adapted to support in-growth of tissue with so it at least partiallycovers the tunnelling.

The present invention further extends to a method of operating theapparatus according to any that comprises activating a control assemblyof the control device; increasing the volume of the expandable member;and discharging urine through the urethra. The method can furthercomprises the step activating the restriction devices to temporarilyclose the ureters and/or a step comprising activating the restrictiondevice to temporarily release its restriction of the urethra or the neckof the urine bladder. In the method a control assembly can receive asignal from a pressure sensor measuring the urinary pressure in theurinary bladder or expandable member, said control assembly comprisingan alarm system adapted to present an alarm signal for the patient,being able to activate said control assembly with a signal from acontrol unit controlled from external to the patient, such as a wirelessremote control or an subcutaneously implantable switch. The method canfurther comprise the step of activating a pump for transportinghydraulic fluid from said reservoir to the expandable member.

The present invention sin yet another embodiment extends to a method ofreplacing an expandable member in the previous described apparatus fortreating urinary retention comprising the steps of inserting aninstrument adapted to operate on the expandable member through theurethra;

releasing the expandable member from the control device; displacing thecollapsed expandable member with the instrument; and transporting thecollapsed expandable member through the urethra and out of the body.Further, the method comprises inserting a new, collapsed expandablemember through the urethra; displacing the expandable member to acoupling position with control device; and attaching the expandablemember to the control device with a quick coupling.

The present invention also relates to a system treating urinaryincontinence comprising the previously described apparatus. Parts orcomponents of system are described in the following sections of thedescription and should be regarded as applicable with any apparatusdescribed above. In a one embodiment, the system comprises at least oneswitch implantable in the patient for manually and non-invasivelycontrolling the apparatus

In another embodiment, the system comprises a wireless remote controlfor non-invasively controlling the apparatus.

In one embodiment, the system comprises a hydraulic operation device foroperating the apparatus.

In one embodiment, the system comprises comprising a motor or a pump foroperating the apparatus.

Further embodiments are defined by the dependent claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will now be described in more detail by way ofnon-limiting examples and with reference to the accompanying drawings,in which:

FIGS. 1 a and 1 b are views of an implantable fluid movement device inaccordance with a first embodiment,

FIG. 2 is a view of an implantable fluid movement device in accordancewith a second embodiment, and

FIG. 3 is a flowchart illustrating different steps performed whenimplanting an implantable fluid movement device.

FIG. 4 is a sectional view of a cleaning device according to theinvention.

FIG. 5 is a cross sectional view of the cleaning device of FIG. 4 takenalong the line III-III before a cleaning operation.

FIG. 6 is a sectional view of the cleaning device of FIG. 4 taken alongthe line IV-IV.

FIG. 7 is a sectional view similar to that of FIG. 4 showing particlesbefore a cleaning operation.

FIG. 8 is a sectional view similar to that of FIG. 4 during a first stepof a cleaning operation.

FIG. 9 is a sectional view similar to that of FIG. 4 during a secondstep of a cleaning operation.

FIG. 10 is a sectional view similar to that of FIG. 4 during a thirdstep of a cleaning operation.

FIG. 11 is a cross sectional view similar to that of FIG. 5 during acleaning operation.

FIG. 12 is a sectional view of the cleaning device of FIG. 10 takenalong the line X-X showing a cleaning ejection piston before ejection ofparticles.

FIG. 13 is a view similar to that of FIG. 11 but after ejection ofparticles.

FIG. 14 is a schematic diagram of a cleaning system.

FIGS. 15-30 show various embodiments based on the system of FIG. 14.

FIG. 31 is a view of an alternative embodiment of a cleaning system.

FIG. 32 is a general view of an implanted drainage system in a patient.

FIG. 33 is a detailed view of a drainage system.

FIGS. 34 a-34 d are views of exemplary designs of tube ends fordifferent treatment areas.

FIG. 35 is a view of a securing arrangement for securing a tube end in abladder, such as the urine bladder.

FIG. 36 a is a circuit diagram showing an energy transfer amplifier,where the energy is transferred by ultrasonic waves.

FIG. 36 b is a circuit diagram showing further another embodiment of anamplifier.

FIG. 36 c-d are graphs showing different waveforms of signals in theamplifier of the ultrasonic embodiment.

FIG. 37 is general view of an implanted drainage apparatus with a filterin a patient.

FIG. 38 is a detailed view of a powered filter.

FIGS. 39 a and 39 b are views of a filter cassette.

FIGS. 40 a and 40 b are views of a filter cassette.

FIG. 41 shows the placement in the body of a hydraulic treatmentembodiment.

FIG. 42-43 describes a hydraulic treatment embodiment for emptying theurine bladder.

DETAILED DESCRIPTION

In FIGS. 1 a and 1 b a view illustrating an implantable fluid movementdevice 100. The device 100 comprises a bellow 101 adapted to movebetween a compressed position in which the bellow has a small insidevolume and an expanded position in which the bellow has a larger insidevolume. The view in FIG. 1 a shows the bellow in a compressed positionand the view in FIG. 1 b shows the bellow in an expanded position.

The device 100 further comprises a member such as screw 103 adapted tocompress the bellow 101. The screw 103 is accordance with one embodimentdriven by a motor 105. The motor may many type of suitable motorincluding but not limited an electrical motor and a hydraulic motor. Inaccordance with one embodiment the motor is associated with a clutch 107for regulating the power applied to the screw 103.

The inside of the bellow 101 is adapted receive and eject body fluid.The body fluid enters the bellow via an inlet 109 when the bellowexpands. The fluid exits the bellow 101 via an outlet 111 when thebellow is compressed. In order for the fluid to only enter the bellowvia the inlet when the bellow expands, a valve 113 is provided toprevent fluid to enter via the outlet 111 during the expansion phase.Similarly, the valve 113 is adapted to prevent fluid to exit via theinlet 109 when the bellow is compressed. The valve 113 is controlled bya control member 115 such as a solenoid.

The inlet and outlet are shaped to have tubes (not shown) fittedthereon. The tube connected to the inlet is preferably shaped andadapted to be placed in a treatment area from which body fluid is to beremoved. The tube connected to the outlet is preferably shaped andadapted to be placed in a delivery area to which body fluid is to bemoved from the treatment area.

During operation the device is adapted to compress the bellow in acompression phase during which fluid is ejected from the device 100 viathe outlet tube to the delivery area for example by driving the motor todrive the screw. In a preferred embodiment a spring 117 is alsocompressed during the compression phase. During operation the device isfurther adapted to expand the bellow in an expansion phase during whichfluid is sucked into the device 100 via the inlet tube from thetreatment area for example by driving the screw in the oppositedirection. In a preferred embodiment the spring 117 drives the bellow toexpand during the expansion phase. When treating a patient thecompression phase and expansion phase are continuously repeated wherebybody fluid is removed from the treatment area to the delivery area.

In FIG. 2 the device 100 is shown as supplemented with a control unit119 for controlling the operation of the device 100. The control unit119 can receive and transmit signals for a remote unit 121. The unit 121is typically located outside the body when the device 100 is implantedinside a patient. In addition the device can be provided with achargeable power source 123 connected to the motor. The power source 123is adapted to receive wireless power from a second power source 125which typically is located outside the patient when the implantabledevice 100 is implanted in a patient. Hereby the power source 123 can berecharged at suitable time intervals thereby removing the need forreplacing the power source.

In order to prevent or remove a possible occlusion in the tube the fluidmovement device can be provided with a backward release member 126adapted to generate a backward pressure of fluid or air in the tube forremoving or preventing a possible occlusion in the tube. The backwardpressure is preferably repeatedly according to a predetermined timeschedule. In accordance with one embodiment the release member comprisesa pre-pressurized reservoir of air and a valve adapted to release a puffof air in the tube. In accordance with another embodiment the device 100is adapted to move fluid or air in the tube in the reversed directionthereby creating a reverse flow for prevent or remove a possibleocclusion in the tube. This can for example be obtained by controllingthe valve 113 to a reversed more of operating so that fluid exits thedevice 100 via the inlet. In accordance with yet another embodiment areservoir of the drainage is pre-pressurized by the pump, and a valve ofthe device is adapted to release a puff of fluid or air in the tubeextending from the pre-pressurized reservoir when the pressure hasreached a predetermined level.

In FIG. 3 a flowchart illustrating step performed when implanting thedevice 100 in a patient. First in a step 301 the skin is cut atlocations corresponding to the location where the device is to be placedand where the tubes leading to and from the device are going to beplaced. Next, in a step 303 the area from which body fluid is to beremoved, the treatment area is dissected. Then, in a step 305, the areato which body fluid is to be moved, the delivery area, is dissected.Thereupon, in a step 307, the area where the device is to be placed, theplacement area is dissected, if the placement area is different from thetreatment area and the delivery area. Next, in a step 309 the device isplaced in the placement area and the tubes extending between the deviceand the treatment area and the delivery area are put into place in steps311 and 313, respectively.

In accordance with one embodiment a cleaning device 10 is inserted inthe flow passageway from the treatment area to where the fluid is moved,I.e. the delivery area.

The design of a first preferred embodiment of a cleaning device 10 willnow be described in detail, with reference to FIGS. 4-6. FIG. 4 shows asectional view wherein the cleaning device 10 is provided in the flowpassageway provided by a tube 2 b. A filter 12 is provided across theflow passageway 14 formed in a housing 11 with the function of stoppingparticles brought forward in tube 2 b by the flow, indicated by arrowsin the figure. In this preferred embodiment, the filter 12 comprises aplurality of preferably equally spaced strips 12 a of some suitablematerial, such as biocompatible metal or plastic. These strips 12 a arepreferably arranged mutual parallel.

The distance between two adjacent strips is small enough to stop anyparticles larger than some predetermined size. In accordance with oneembodiment the distance is less than 2 millimeters, and even less than1.0 millimeters. Also for some applications the distance could belarger. The flow passageway 14 can have an essentially squarecross-sectional shape or can it can take any suitable shape, such asrectangular or circular.

By providing a plurality of strips 12 a as a filter across the flowpassageway 14, a laminar flow is achieved downstream of the filter,which is can be advantageous. The flow configuration can be furtherenhanced by giving the plurality of strips 12 a a desiredcross-sectional shape, although the rectangular shape shown in FIG. 6will be adequate for most purposes.

A first piston 16 is provided movable in a direction essentiallyperpendicular to the direction of the flow passageway 14, i.e.,essentially perpendicular to the direction of the flow. This firstpiston 16 is driven by some suitable actuator means, such as pressurizedair, a solenoid arrangement, an electrical servo motor or the like. Amotor could be used to build up a stored power that could be releasedvery fast, one example being a spring. In a preferred embodiment,pressurized air acts as the actuator means, since by latching the pistonby means of a suitable latching means for the piston, building up theair pressure, and subsequently releasing the piston, very high speed ofthe piston is achieved, with enables short cleaning times of the filter.

The outer end portion of the first piston 16, i.e., the end portionfacing the flow passageway 14, is essentially flush with the wall of theflow passageway in a non-active state of the cleaning device 10. Also,the outer end portion is provided with a concave portion or recess 16 a(exaggerated in the figures) in order to act as a particle capturingmeans, as will be explained below.

The strike range of the first piston 16 is preferably such that itextends all way across the flow passageway 14, as will be explainedbelow with reference to FIGS. 7-10. A number of channels 16 bcorresponding to the number of strips 12 a is provided in the firstpiston 16 to accommodate the strips when the first piston is in anextended position.

The first piston 16 is also provided with a plurality of through holes17 in the direction of the flow passageway. These through holes willallow a flow through the flow passageway also during a cleaningoperation, as will be explained below with reference to FIG. 11.

A second piston 18 is provided across the flow passageway 14 from thefirst piston 16. Also this second piston 18 is movable in a directionessentially perpendicular to the direction of the flow passageway 14 andis biased in the direction thereof by means of a spring 18 a, forexample. Likewise, the outer end portion of the second piston isprovided with a recess 18 b similar to the recess 16 a of the firstpiston 16.

The first and second pistons 16, 18, are sealed to the housing 11 bymeans of a respective sealing 20, such as an O sealing.

A preferred embodiment of a cleaning method according to the inventionwill now be described with reference to FIGS. 7-10, showing differentoperational steps of the above-described device. FIG. 7 is a viewsimilar to that of FIG. 4. However, this figure shows the cleaningdevice 10 during operation, wherein particles, generally designated 22,have assembled on the filter 12.

In FIG. 8, the first piston 16 has moved linearly from the retractedstarting position shown FIG. 7 to an extended position, wherein theouter end portion thereof is in contact with the second piston 18. Dueto the recess 16 a in the outer end of the first piston 16, theparticles 22 have been assembled in the recess 16 a, whereby they havebeen brought with the first piston 16 during the movement thereof. Inthe step shown in FIG. 8, the particles are confined in the recess 16 abetween the first and second pistons 16, 18.

By moving the first piston 16 an additional distance from the positionshown in FIG. 8, the second piston 18 is pushed against the force of thespring 18 a to a fully retracted position, see FIG. 9. The plurality ofstrips 12 a is in this position fully received in a respective channel16 b in the first piston. It is seen that the outer ends of the firstand second pistons define an unobstructed cavity in which the particlesare confined. It is thereby possible to remove these by some suitablemeans. One such means could be a third piston 24, which is movable in adirection perpendicular to both the direction of the flow passageway 14and the direction of movement of the first and second pistons 16, 18.This third piston, the movement of which could be controlled by means ofpressurized air, a solenoid, an electric motor etc., scrapes off theparticles collected by the first piston 16 and moves them to a placeoutside of the cleaning device 10 and the flow passageway 14.

FIG. 11 shows a side view of the first piston 16 in a fully extendedposition, i.e., corresponding to the view of FIG. 10. It is here seenthat in this position the through holes 17 will be aligned with the flowpassageway 14, thereby allowing a flow therethrough also during cleaningof the filter 12.

FIG. 12 shows a cross-sectional view taken along line X-X of FIG. 10. Itis here seen that the third piston 24 collects the particles 22 during adownward movement, indicated by an arrow in the figure. The particlesare ejected from the cleaning device 10 when the third piston 24 hasreached its lower end position, shown in FIG. 13.

Again with reference to FIG. 9, it will be realized that pressurized aircan be used for ejecting the collected particles from the cavity formedby the first piston 16 and the second piston 18.

A cleaning system, generally designated 28 and comprising a cleaningdevice as described above will now be described with reference to FIGS.14-26.

A cleaning system is shown in a more generalized block diagram form inFIG. 14, wherein the patient's skin 36, generally shown by a verticalline, separates the interior of the patient to the right of the linefrom the exterior to the left of the line.

FIG. 15 shows an embodiment of the invention identical to that of FIG.14, except that a reversing device in the form of an electric switch 38operable by polarized energy also is implanted in the patient forreversing the cleaning device 10. The wireless remote control of theexternal energy transmission device 34 transmits a wireless signal thatcarries polarized energy and the implanted energy transforming device 30transforms the wireless polarized energy into a polarized current foroperating the electric switch 38. When the polarity of the current isshifted by the implanted energy transforming device 30 the electricswitch 38 reverses the function performed by the cleaning device 10.

FIG. 16 shows an embodiment of the invention identical to that of FIG.14, except that an operation device 40 implanted in the patient forregulating the cleaning device 10 is provided between the implantedenergy transforming device 30 and the cleaning device 10. This operationdevice can be in the form of a motor 40, such as an electric servomotor. The motor 40 is powered with energy from the implanted energytransforming device 30, as the remote control of the external energytransmission device 34 transmits a wireless signal to the receiver ofthe implanted energy transforming device 30.

FIG. 17 shows an embodiment of the invention identical to that of FIG.14, except that it also comprises an operation device is in the form ofan assembly 42 including a motor/pump unit 78 and a fluid reservoir 46is implanted in the patient. In this case the cleaning device 10 ishydraulically operated, i.e. hydraulic fluid is pumped by the motor/pumpunit 44 from the fluid reservoir 46 through a conduit 48 to the cleaningdevice 10 to operate the cleaning device, and hydraulic fluid is pumpedby the motor/pump unit 44 back from the cleaning device 10 to the fluidreservoir 46 to return the cleaning device to a starting position. Theimplanted energy transforming device 30 transforms wireless energy intoa current, for example a polarized current, for powering the motor/pumpunit 44 via an electric power supply line 50.

Instead of a hydraulically operated cleaning device 10, it is alsoenvisaged that the operation device comprises a pneumatic operationdevice. In this case, pressurized air can be used for regulation and thefluid reservoir is replaced by an air chamber and the fluid is replacedby air.

FIG. 18 shows an embodiment of the invention comprising the externalenergy transmission device 34 with its wireless remote control, thecleaning device 10, in this case hydraulically operated, and theimplanted energy transforming device 30, and further comprising ahydraulic fluid reservoir 52, a motor/pump unit 44 and an reversingdevice in the form of a hydraulic valve shifting device 54, allimplanted in the patient. The motor of the motor/pump unit 44 is anelectric motor. In response to a control signal from the wireless remotecontrol of the external energy transmission device 34, the implantedenergy transforming device 30 powers the motor/pump unit 44 with energyfrom the energy carried by the control signal, whereby the motor/pumpunit 44 distributes hydraulic fluid between the hydraulic fluidreservoir 52 and the cleaning device 10. The remote control of theexternal energy transmission device 34 controls the hydraulic valveshifting device 54 to shift the hydraulic fluid flow direction betweenone direction in which the fluid is pumped by the motor/pump unit 44from the hydraulic fluid reservoir 52 to the cleaning device 10 tooperate the cleaning device, and another opposite direction in which thefluid is pumped by the motor/pump unit 44 back from the cleaning device10 to the hydraulic fluid reservoir 52 to return the cleaning device toa starting position.

FIG. 19 shows an embodiment of the invention identical to that of FIG.14, except that an internal control unit 56 controlled by the wirelessremote control of the external energy transmission device 34, anaccumulator 58 and a capacitor 60 also are implanted in the patient. Theinternal control unit 56 arranges storage of electric energy receivedfrom the implanted energy transforming device 30 in the accumulator 58,which supplies energy to the cleaning device 10. In response to acontrol signal from the wireless remote control of the external energytransmission device 34, the internal control unit 56 either releaseselectric energy from the accumulator 58 and transforms the releasedenergy via power lines 62 and 64, or directly transforms electric energyfrom the implanted energy transforming device 30 via a power line 66,the capacitor 60, which stabilizes the electric current, a power line 68and the power line 64, for the operation of the cleaning device 10.

The internal control unit is preferably programmable from outside thepatient's body. In a preferred embodiment, the internal control unit isprogrammed to regulate the cleaning device 10 to remove any particlesfrom the fluid movement device and place the particles outside the fluidmovement device repeatedly according to a pre-programmed time-schedule.

In accordance with an alternative, the capacitor 60 in the embodiment ofFIG. 19 may be omitted. In accordance with another alternative, theaccumulator 58 in this embodiment may be omitted.

FIG. 20 shows an embodiment of the invention identical to that of FIG.14, except that a battery 70 for supplying energy for the operation ofthe cleaning device 10 and an electric switch 72 for switching theoperation of the cleaning device 10 also are implanted in the patient.The electric switch 72 is operated by the energy supplied by theimplanted energy transforming device 30 to switch from an off mode, inwhich the battery 70 is not in use, to an on mode, in which the battery70 supplies energy for the operation of the cleaning device 10.

FIG. 21 shows an embodiment of the invention identical to that of FIG.20, except that an internal control unit 56 controllable by the wirelessremote control of the external energy transmission device 34 also isimplanted in the patient. In this case, the electric switch 72 isoperated by the energy supplied by the implanted energy transformingdevice 30 to switch from an off mode, in which the wireless remotecontrol is prevented from controlling the internal control unit 56 andthe battery is not in use, to a standby mode, in which the remotecontrol is permitted to control the internal control unit 56 to releaseelectric energy from the battery 70 for the operation of the cleaningdevice 10.

FIG. 22 shows an embodiment of the invention identical to that of FIG.21, except that an accumulator 58 is substituted for the battery 70 andthe implanted components are interconnected differently. In this case,the accumulator 58 stores energy from the implanted energy transformingdevice 30. In response to a control signal from the wireless remotecontrol of the external energy transmission device 34, the internalcontrol unit 56 controls the electric switch 72 to switch from an offmode, in which the accumulator 58 is not in use, to an on mode, in whichthe accumulator 58 supplies energy for the operation of the cleaningdevice 10.

FIG. 23 shows an embodiment of the invention identical to that of FIG.22, except that a battery 70 also is implanted in the patient and theimplanted components are interconnected differently. In response to acontrol signal from the wireless remote control of the external energytransmission device 34, the internal control unit 56 controls theaccumulator 58 to deliver energy for operating the electric switch 72 toswitch from an off mode, in which the battery 70 is not in use, to an onmode, in which the battery 70 supplies electric energy for the operationof the cleaning device 10.

Alternatively, the electric switch 72 may be operated by energy suppliedby the accumulator 58 to switch from an off mode, in which the wirelessremote control is prevented from controlling the battery 70 to supplyelectric energy and is not in use, to a standby mode, in which thewireless remote control is permitted to control the battery 70 to supplyelectric energy for the operation of the cleaning device 10.

FIG. 24 shows an embodiment of the invention identical to that of FIG.20, except that a motor 40, a mechanical reversing device in the form ofa gear box 74, and an internal control unit 56 for controlling the gearbox 74 also are implanted in the patient. The internal control unit 56controls the gear box 74 to reverse the function performed by thecleaning device 10 (mechanically operated).

FIG. 25 shows an embodiment of the invention identical to that of FIG.23 except that the implanted components are interconnected differently.Thus, in this case the internal control unit 56 is powered by thebattery 70 when the accumulator 58, suitably a capacitor, activates theelectric switch 72 to switch to an on mode. When the electric switch 72is in its on mode the internal control unit 56 is permitted to controlthe battery 70 to supply, or not supply, energy for the operation of thecleaning device 10.

FIG. 26 schematically shows conceivable combinations of implantedcomponents of the apparatus for achieving various communication options.Basically, there are the cleaning device 10, the internal control unit56, motor/pump unit 44, and the external energy transmission device 34including the external wireless remote control. As already describedabove the wireless remote control transmits a control signal which isreceived by the internal control unit 56, which in turn controls thevarious implanted components of the apparatus.

A feedback device, preferably in the form of a sensor 76, may beimplanted in the patient for sensing a physical parameter of thepatient, such as the pressure in a blood vessel. The internal controlunit 56, or alternatively the external wireless remote control of theexternal energy transmission device 34, may control the cleaning device10 in response to signals from the sensor 76. A transceiver may becombined with the sensor 76 for sending information on the sensedphysical parameter to the external wireless remote control. The wirelessremote control may comprise a signal transmitter or transceiver and theinternal control unit 56 may comprise a signal receiver or transceiver.Alternatively, the wireless remote control may comprise a signalreceiver or transceiver and the internal control unit 56 may comprise asignal transmitter or transceiver. The above transceivers, transmittersand receivers may be used for sending information or data related to thecleaning device 10 from inside the patient's body to the outsidethereof.

Alternatively, the sensor 76 may be arranged to sense a functionalparameter of the cleaning device 10.

Where the motor/pump unit 44 and battery 70 for powering the motor/pumpunit 44 are implanted, the battery 70 may be equipped with a transceiverfor sending information on the condition of the battery 70.

FIG. 27 shows an alternative embodiment wherein the cleaning device 10is regulated from outside the patient's body. The cleaning system 28comprises a cleaning device 10 connected to a battery 70 via asubcutaneous switch 80. Thus, the regulation of the cleaning device 10is performed non-invasively by manually pressing the subcutaneousswitch, whereby the operation of the cleaning device 10 is switched onand off. It will be appreciated that the shown embodiment is asimplification and that additional components, such as an internalcontrol unit, can be added to the cleaning system.

FIG. 28 shows an alternative embodiment, wherein the cleaning system 28comprises a cleaning device 10 in fluid connection with a hydraulicfluid reservoir 52. Non-invasive regulation is performed by manuallypressing the hydraulic reservoir connected to the cleaning device 10.

A further embodiment of a system according to the invention comprises afeedback device for sending information from inside the patient's bodyto the outside thereof to give feedback information related to at leastone functional parameter of the clot removal device or system or aphysical parameter of the patient, thereby optimizing the performance ofthe system.

One preferred functional parameter of the device is correlated to thetransfer of energy for charging the internal energy source.

In FIG. 29, an arrangement is schematically illustrated for supplying anaccurate amount of energy to a cleaning system 28 implanted in apatient, whose skin 36 is indicated by a vertical line. A cleaningdevice 10 is connected to an implanted energy transforming device 30,likewise located inside the patient, preferably just beneath thepatient's skin 36. Generally speaking, the implanted energy transformingdevice 30 may be placed in the abdomen, thorax, muscle fascia (e.g. inthe abdominal wall), subcutaneously, or at any other suitable location.The implanted energy transforming device 30 is adapted to receivewireless energy E transmitted from an external energy source 34 aprovided in the external energy transmission device 34 located outsidethe patient's skin 36 in the vicinity of the implanted energytransforming device 30.

As is well known in the art, the wireless energy E may generally betransferred by means of any suitable Transcutaneous Energy Transfer(TET) device, such as a device including a primary coil arranged in theexternal energy source 34 a and an adjacent secondary coil arranged inthe implanted energy transforming device 30. When an electric current isfed through the primary coil, energy in the form of a voltage is inducedin the secondary coil which can be used to operate a cleaning device,e.g. after storing the incoming energy in an energy storing device oraccumulator, such as a battery or a capacitor. However, the presentinvention is generally not limited to any particular energy transfertechnique, TET devices or energy storing devices, and any kind ofwireless energy may be used. Other energy transfer methods include butare not limited to non-induction methods such as by means of ultra-sonicdevices or using light.

The amount of transferred energy can be regulated by means of anexternal control unit 34 b controlling the external energy source 34 abased on the determined energy balance, as described above. In order totransfer the correct amount of energy, the energy balance and therequired amount of energy can be determined by means of an internalcontrol unit 56 connected to the cleaning device 10. The internalcontrol unit 56 may thus be arranged to receive various measurementsobtained by suitable sensors or the like, not shown, measuring certaincharacteristics of the cleaning device 10, reflecting the requiredamount of energy needed for proper operation of the cleaning device 10.Moreover, the current condition of the patient may also be detected bymeans of suitable measuring devices or sensors, in order to provideparameters reflecting the patient's condition. Hence, suchcharacteristics and/or parameters may be related to the current state ofthe cleaning device 10, such as power consumption, operational mode andtemperature, as well as the patient's condition reflected by, e.g., bodytemperature, blood pressure, heartbeats and breathing.

Furthermore, an energy storing device or accumulator 58 may optionallybe connected to the implanted energy transforming device 30 foraccumulating received energy for later use by the cleaning device 10.Alternatively or additionally, characteristics of such an accumulator,also reflecting the required amount of energy, may be measured as well.The accumulator may be replaced by a battery, and the measuredcharacteristics may be related to the current state of the battery, suchas voltage, temperature, etc. In order to provide sufficient voltage andcurrent to the cleaning device 10, and also to avoid excessive heating,it is clearly understood that the battery should be charged optimally byreceiving a correct amount of energy from the implanted energytransforming device 30, i.e. not too little or too much. The accumulatormay also be a capacitor with corresponding characteristics.

For example, battery characteristics may be measured on a regular basisto determine the current state of the battery, which then may be storedas state information in a suitable storage means in the internal controlunit 56. Thus, whenever new measurements are made, the stored batterystate information can be updated accordingly. In this way, the state ofthe battery can be “calibrated” by transferring a correct amount ofenergy, so as to maintain the battery in an optimal condition.

Thus, the internal control unit 56 is adapted to determine the energybalance and/or the currently required amount of energy, (either energyper time unit or accumulated energy) based on measurements made by theabove-mentioned sensors or measuring devices on the cleaning device 10,or the patient, or an energy storing device if used, or any combinationthereof The internal control unit 56 is further connected to an internalsignal transmitter 82, arranged to transmit a control signal reflectingthe determined required amount of energy, to an external signal receiver34 c connected to the external control unit 34 b. The amount of energytransmitted from the external energy source 34 a may then be regulatedin response to the received control signal.

Alternatively, sensor measurements can be transmitted directly to theexternal control unit 34 b wherein the energy balance and/or thecurrently required amount of energy can be determined by the externalcontrol unit 34 b, thus integrating the above-described function of theinternal control unit 56 in the external control unit 34 b. In thatcase, the internal control unit 56 can be omitted and the sensormeasurements are supplied directly to the internal signal transmitter 82which sends the measurements over to the external signal receiver 34 cand the external control unit 34 b. The energy balance and the currentlyrequired amount of energy can then be determined by the external controlunit 34 b based on those sensor measurements.

Hence, feedback of information indicating the required energy can beused, which is more efficient because it is based on the actual use ofenergy that is compared to for example the received energy, e.g. withrespect to the amount of energy, the energy difference, or the energyreceiving rate as compared to the energy rate used by the cleaningdevice. The cleaning device may use the received energy either forconsuming or for storing the energy in an energy storage device or thelike. The different parameters discussed above would thus be used ifrelevant and needed and then as a tool for determining the actual energybalance. However, such parameters may also be needed per se for anyactions taken internally to specifically operate the clot removaldevice.

The internal signal transmitter 82 and the external signal receiver 34 cmay be implemented as separate units using suitable signal transfermeans, such as radio, IR (Infrared) or ultrasonic signals.Alternatively, the internal signal transmitter 82 and the externalsignal receiver 34 c may be integrated in the implanted energytransforming device 30 and the external energy source 34 a,respectively, so as to convey control signals in a reverse directionrelative to the energy transfer, basically using the same transmissiontechnique. The control signals may be modulated with respect tofrequency, phase or amplitude.

The energy supply arrangement illustrated in FIG. 29 may operatebasically in the following manner. The energy balance is firstdetermined by the internal control unit 56. A control signal reflectingthe required amount of energy is also created by the internal controlunit 56, and the control signal is transmitted from the internal signaltransmitter 82 to the external signal receiver 34 c. Alternatively, theenergy balance can be determined by the external control unit 34 binstead depending on the implementation, as mentioned above. In thatcase, the control signal may carry measurement results from varioussensors. The amount of energy emitted from the external energy source 34a can then be regulated by the external control unit 34 b, based on thedetermined energy balance, e.g. in response to the received controlsignal. This process may be repeated intermittently at certain intervalsduring ongoing energy transfer, or may be executed on a more or lesscontinuous basis during the energy transfer.

The amount of transferred energy can generally be regulated by adjustingvarious transmission parameters in the external energy source 34 a, suchas voltage, current, amplitude, wave frequency and pulsecharacteristics.

A method is thus provided for controlling transmission of wirelessenergy supplied to an electrically operable cleaning device implanted ina patient. The wireless energy E is transmitted from an external energysource located outside the patient and is received by an internal energyreceiver located inside the patient, the internal energy receiver beingconnected to the clot removal device for directly or indirectlysupplying received energy thereto. An energy balance is determinedbetween the energy received by the internal energy receiver and theenergy used for the cleaning device. The transmission of wireless energyE from the external energy source is then controlled based on thedetermined energy balance.

A system is also provided for controlling transmission of wirelessenergy supplied to an electrically operable cleaning device implanted ina patient. The system is adapted to transmit the wireless energy E froman external energy source located outside the patient which is receivedby an implanted energy transforming device located inside the patient,the implanted energy transforming device being connected to the cleaningdevice for directly or indirectly supplying received energy thereto. Thesystem is further adapted to determine an energy balance between theenergy received by the implanted energy transforming device and theenergy used for the cleaning device, and control the transmission ofwireless energy E from the external energy source, based on thedetermined energy balance.

The functional parameter of the device is correlated to the transfer ofenergy for charging the internal energy source.

In yet an alternative embodiment, the external source of energy iscontrolled from outside the patient's body to release electromagneticwireless energy, and released electromagnetic wireless energy is usedfor operating the cleaning device.

In another embodiment, the external source of energy is controlling fromoutside the patient's body to release non-magnetic wireless energy, andreleased non-magnetic wireless energy is used for operating the cleaningdevice.

Those skilled in the art will realize that the above various embodimentsaccording to FIGS. 14-30 could be combined in many different ways. Forexample, the electric switch 38 operated polarized energy could beincorporated in any of the embodiments of FIGS. 16, 19-25, the hydraulicvalve shifting device 54 could be incorporated in the embodiment of FIG.17, and the gear box 74 could be incorporated in the embodiment of FIG.16.

Wireless transfer of energy for operating the cleaning device has beendescribed to enable non-invasive operation. It will be appreciated thatthe cleaning device can be operated with wire bound energy as well. Onesuch example is shown in FIG. 30, wherein an external switch 84 isinterconnected between the external energy source 34 a and an operationdevice, such as an electric motor regulating the cleaning device 10, bymeans of power lines 86 and 88. An external control unit 34 b controlsthe operation of the external switch to effect proper operation of thecleaning device 10.

Also other filters can be used in the cleaning device 10. One suchfilter is depicted in FIG. 31. The filter 90 in FIG. 31 comprises arotating member 91 located in the flow passage way of the fluid movementdevice. The rotating member can be formed by a number of segments 92.Particles in the flow will caught by the segments and moved to the rimof the rotating member 91 where the particles can be effectively removedfrom the flow pathway of the fluid movement device. The cleaning devicein FIG. 31 can be powered in the same manner as the cleaning devicedescribed above.

In FIG. 32 a general view of a patient having an implanted drainagesystem as described herein. The system comprises a first end of thedrainage system located in a treatment area 1. The system furthercomprises a pump 100 adapted to move fluid from the treatment area 1 toa delivery area 3. The treatment area can be any area from which fluidis to be move including but not limited to the abdomen, the lungs andthe brain. Similarly the delivery area can be any suitable delivery areawithin the body, including but not limited to the Urine bladder and thestomach.

The pump can be powered by an energy source 123 as described above. Theenergy source can be energized from outside the patient using a wirelessenergy transfer device. The energy transfer device can transfer energyin a way suitable such as by inductive energy using coils or ultra sonicenergy transfer or by transmitting light through the skin of thepatient. Also the fluid passageway from the treatment area to thedelivery area can comprise a cleaning device 10 as described above. Thecleaning device can in one embodiment be powered by a motor and themotor can then be supplied with energy from the energy source 123.

In FIG. 33 the drainage system is shown in more detail. The view in FIG.33 corresponds to the view in FIG. 32. However instead of showing thetreatment area 1, FIG. 33 shows and end member 4 of the tube located inthe treatment area. As described above the end member 4 can be designeddifferently for different treatment areas. Different end members aredescribed in more detail below.

In FIGS. 34 a-34 d different exemplary designs of end members 4 areshown in more detail. Thus, a connecting tube for use in an implantablefluid movement device being adapted to move body fluid from one part ofthe body, herein termed treatment area, of a human or mammal patient isprovided. A distal end of the connecting tube comprises in accordancewith one embodiment a portion having a flat shape. Such an end portioncan advantageously be used in the lungs when moving fluid from thelungs. The end portion can have an essential circular shape as is shownin FIG. 34 a or have a polygonal shape as is shown in FIG. 34 b.

In accordance with one embodiment the distal end of the connecting tubecan comprises a portion having a generally cylindrical shape as is shownin FIG. 34 c. Such a shape can be preferred in applications where thereis a risk that the tube end is sucked towards the wall of the treatmentarea. In FIG. 34 d yet another embodiment is shown with a very flexibletube end that can be used as a versatile tube in that it combinesadvantages of a flat tube end and a cylindrical tube end at the expenseof the disadvantages of being flexible.

The tube ends are provided with holes or formed by a netlike structure.The diameter of the hole can in accordance with one embodiment be in therange of 1-10 mm. The number of holes and the diameter can typicallydepend on the treatment. As a general rule more holes and larger holeswill give a lower sucking force and vice versa. Thus, areas where a lowsucking force is required such as in the lungs can be treated using atube end having many and large holes in the tube end.

In FIG. 35 a securing arrangement for securing a second end of a tube ofthe fluid movement device into the urine bladder is depicted. Thearrangement comprises a tube end placed in the urine bladder 3 through ahole made in the wall of the urine bladder. On the outside the tube isled through a tunnel 95 formed by folding the outside wall of the urinebladder around the tube. The tunnel is secured around the tube bysutures 97 or similar. At the end of the tunnel a net structure 96 istightly secured to the tube. The net structure has small diametertypically smaller than 0.5 mm. In any event the net structure has holesthat will be small enough to be overgrown by tissue thereby providing atight sealing so that no leakage occur. As stated above energy can betransferred in different manners from outside a patient into a implanteddrain as described herein. In particular the energy can be transferredby means of an inductive energy transfer or by transmission using anultrasonic energy transmission, or by transmission of energy usinglight. In FIG. 36 a a triangle wave generator circuit which output isconnected as an input terminal of an amplifier used for transmittingenergy using an ultrasonic energy transmission. In FIGS. 36 a and 36 bthe symbols Y1, Y2, Y3 and so on symbolize test points within thecircuit. The components in the circuit diagrams and their respectivevalues are values that work in this particular implementation which ofcourse is only one of an infinite number of possible design solutions.

FIG. 36 a shows a circuit diagram containing most of an exemplaryamplifier, in the lower left corner of FIG. 36 a there is the LF inputwhich is the input for the 25 kHz sine wave that should be amplifiedinto a digital output signal. The LF-input there is the triangle waveinput emanating from the Triangle schematic. To the right in the middlein the Core schematic there is the transmitting crystal, X4, connectedto the differential digital outputs, positive and negative output, ofthe amplifier. The transmitting crystal X4 is in series with itsassociated tuning circuit components tuned to the sending frequency,which in this particular case is 25 kHz. FIGS. 36 c-36 d displays therelationship between the input and the output signal of the amplifier,in FIG. 36 c Y25 is the input signal and Y2 is the positive digitaloutput signal from the amplifier and in FIG. 36 d Y13 is the negativedigital output from the amplifier.

As described above the implanted drainage device can be powered by aninternal power supply. The same power supply or another power supply canbe used to provide energy the filter and or cleaning device 10 asdescribed herein. In FIG. 37 a general view similar to the view in FIG.32 is shown where the filter and the cleaning device 10 is connected toa power supply. The apparatus in FIG. 37 comprises a first end of thedrainage apparatus located in a treatment area 1. The apparatus furthercomprises a pump 100 adapted to move fluid from the treatment area 1 toa delivery area 3. The treatment area can be any area from which fluidis to be move including but not limited to the abdomen, the lungs andthe brain. Similarly the delivery area can be any suitable delivery areawithin the body, including but not limited to the Urine bladder and thestomach. The apparatus can as stated above further comprise a filter andor a cleaning device 10. The filter and or cleaning device 10 can bepowered by an energy source 123 a as described above. The energy sourcecan be the same as the energy source 123 powering a pump, but can alsobe another energy source. The energy source 123 a can be energized fromoutside the patient using a wireless energy transfer device. The energytransfer device can transfer energy in a way suitable such as byinductive energy using coils or ultra sonic energy transfer or bytransmitting light through the skin of the patient. Also the fluidpassageway from the treatment area to the delivery area can comprise acleaning device 10 as described above. The cleaning device can in oneembodiment be powered by a motor and the motor can then be supplied withenergy from the energy source 123 a.

In FIG. 38 the power supply to a filter and a cleaning device 10 isshown in more detail. The view in FIG. 38 corresponds to the view inFIG. 37. However instead of showing the treatment area 1, FIG. 38 showsand end member 4 of the tube located in the treatment area. As is shownin FIG. 38 the energy source 123 and 123 a can be energized from outsidethe skin 5 of a patient by an external energy source 6. The energysource can also receive and transmit information to and from an externalsignaling device 7. The cleaning device can also be connected tochangeable filter cassettes 127. In accordance with one embodiment adirty filter of a cassette 127 is adapted to be replaced by a new filterof the cassette. The filter can also comprise a net structure.

In FIG. 39 a a cassette 127 for holding filters is shown. The cassette27 comprises a revolving cylinder 129 having segments 130 each holding afilter. The cylinder 129 is tightly sealed between two supports 131holding the cylinder 129 in place and providing a tight sealing. Thefluid passage way of an implantable drainage apparatus passes throughthe cassette 127. The cassette is driven by a motor 133 causing thecylinder 129 to revolve at suitable times. The motor is powered by apower supply 123 b. The power supply can be a power supply like thepower supplies 123 or 123 a. In accordance with one embodiment the powersupplies 123, 123 a and 123 b is the one and same power supply. As withthe power supplies 123 and 123 a, the power supply 123 b can receivewireless energy in a suitable form, including but not limited toinductive energy ultrasonic energy, light energy or any other form ofwireless energy set out above. The energy is supplied by an externalwireless energy transmitter 6 adapted to transmit energy through theskin 5 of a patient having the cassette 127 implanted. The power supply132 b can also comprise a control unit as described above forcontrolling the revolving cassette 127. The control unit can providefeedback to the outside and receive input data from an externaltransceiver 7 in a manner similar to the control unit used inconjunction with control of the pump.

In FIG. 39 b the cassette 127 is shown from the side with the supports131 and the revolving cylinder spaced apart is a disassembled view.

In FIG. 40 a an alternative embodiment of the cassette 127 is shown. Theview in FIG. 39 a is similar to the view in FIG. 39 a. In the embodimentin FIG. 40 a a magazine 135 having a number of cylinders 129 storedtherein is provided. Hereby a cylinder 129 can by replaced by shiftingthe cylinders in the magazine 135. In one embodiment the cylinders areshifted by pressurized air.

In FIG. 40 b the cassette 127 is shown from the side with the supports131 and the revolving cylinder spaced apart is a disassembled view.

FIGS. 41-43 illustrate an embodiment using hydraulic treatment fluidaccording to the invention.

By reference to FIG. 41 and FIG. 42, the apparatus has an expandablemember 220 with a cavity for accommodating hydraulic fluid that isplaced inside the urinary bladder 230 which contains urine arrived fromthe ureters 232A, 232B. A control device 250 operates the expansion andthereby the volume of the expandable member. The control device 250 hasa control assembly 252 connected to a reservoir 254 for hydraulic fluidwhich is connected to the expandable member with an interconnectingdevice 256 for transporting hydraulic fluid between the reservoir 254and the expandable member 220. The interconnecting device 256 is atube-shaped device surgically incised through the wall of the urinarybladder and attached thereto with tunneling technique whereby thebladder wall is sutured to itself The interconnecting device issupported by the net 258 which seals fixates by admitting tissuein-growth. The control assembly 254 is located in the patient andincludes a number functional elements necessary for operating theapparatus, such as an operating pump 259 for the hydraulic fluid, asource of energy for driving the operating pump and other energyconsuming parts of the apparatus, and control functions includingwireless communication with an external control unit. A suitable controlassembly is described in more detail in the parallel patent applicationno. One or more parts of the control device may be implantedsubcutaneously or in the abdominal cavity or the pelvic region or anyother suitable place inside the body. The embodiment depicted in FIG. 42is adapted for a patient suffering from a complication where the urinarysphincter is permanently closed. For this reason, the expandable member220 of the apparatus needs to exert a considerable pressure (about 60-80cm water pressure) to force urine out from the bladder and urine maythereby backflow through ureters 232A, 232B with potential risks fordamaging the kidneys. To prevent from any such complications, thecontrol device is provided with restriction devices 259A, 259B arrangedto temporarily contract the ureters and close them during the operationof discharging urine with the expandable member. The restriction devicesare operated from the control assembly in manner to perform theirtemporary contraction during the discharge performance. Suitablemechanical or hydraulically operated restriction devices and theircontrol are described in more detail in European Patents Nos. EP1253880; EP 1284691; and EP 1263355. The urine pressure in the ureter isnormally around 50 cm water, however short term pressure increase ismost likely not damaging the kidneys and therefore the restrictiondevices 259A and 259B may be omitted.

When the pump is not pumping to fill the expandable member and if thepassage-way between the reservoir and the expandable member is free,then the expandable member may be emptied by urine filling the bladder.Another alternative is that the pump starts in steps to empty theexpandable member for example pressure controlled or controlled by anyother input sensor as mentioned elsewhere. In another embodiment asecond connection may be established between the expandable member andthe reservoir). If the pumping volume capacity is clearly much largerthan the emptying capacity of the second connection this connection mayalways stand open.

By reference to FIG. 42 and FIG. 43, the apparatus in operated byactivating the operating pump of the control assembly 254 which isoperable in response from a signal from a remote control 253 The controlassembly can also be connected to a pressure sensor 257 for monitoringthe urinary pressure of the bladder. Several different type of inputsensors may be used determining for example stretching or bending orpressure in the urine bladder wall or for example sensing volume orpressure inside the urine bladder. Most likely these sensors is onlyindirect causing the bladder to be emptied by presenting an alarm forthe patient informing that it is time to empty the bladder. Such analarm is generated audible or visually. The remote control may include asubcutaneous switch for controlling the emptying of the bladder orcommunicating via the body used as a wire or with wirelesscommunication. The operating pump now transports hydraulic fluid fromthe reservoir 254, through the interconnection device 256 to the cavityof the expandable member 220, which thereby increases in volume in theurinary bladder and discharges urine through the urethra at a pressurethat overcomes the closing force of the urethral sphincter, so voidingof the urinary bladder is accomplished. During this operation thecontrol assembly operates to close restriction device 259A, 259B toprevent any urinary backflow in the ureters. When the dischargingperformance is finished and the operating pump is inactive, therestriction devices 259A, 259B are released so urine can refill theurinary bladder. By the pressure of the refilled urine, the expandablemember 220 subsequently collapses to retain a shape as shown in FIG. 42when ready for a new performance as monitored by the pressure sensor.

Some patients having urinary retention also have urinary incontinence.In such a case a separate urinary sphincter is included in the system, arestriction device closing the urethra until the patient wants tourinate. In such a case lower pressure is needed to empty the bladderbecause the no force would be needed to open the sphincter by intrabladder pressure. In this case the restriction devices 259A and 259B maybe omitted.

The reservoir 254 may be placed anywhere inside the body, howeverpreferable in the abdominal cavity, maybe placed onto the urine bladderor in the pelvic region. The amount of liquid in the reservoir may becalibrated with fluid by using a injection port placed inside the bodywithin reach from a special injection port needle. The reservoir mayalso be omitted and only the injection port may be used to fill andempty the expandable member. With the described embodiment it is alsoconceivable to control the duration/force of the urine dischargeprocess, e.g. that data from the pressure sensor measuring the urinarypressure or easier the pressure inside the expandable member in thebladder controls the operation pump by logic in the control assembly. Itshould be noted that the expandable member may be elastic or onlyflexible, within the used pressure inside the same.

It should be noted that any embodiment or part of embodiment or featureor method or associated system or part of system described herein may becombined in any combination.

1. An apparatus for moving a fluid to or from a cavity in a human ormammal patient, comprising: a fluid movement device, an energy sourceadapted to supply energy to said fluid movement device, and at least oneconnecting tube connected to said fluid movement device, the fluidmovement device and the tube forming a fluid moving arrangement, whereinthe arrangement is adapted to be implanted inside the body of thepatient, and wherein said tube is to be interconnecting one part, atreatment area, of the body with another part of the body, a deliveryarea, and said fluid movement device is adapted to move fluid from theone part of the body via the connecting tube to the other part of thebody and wherein at least one tube end, is provided with a net structureat a distance from the tube end, wherein the tube is adapted to beinserted into an organ of the patient with a net structure on theoutside in at least one of the delivery area and treatment area.
 2. Theapparatus according to claim 1, wherein the net structure is sealedaround the tube.
 3. The apparatus according to claim 1, wherein the netstructure is provided with holes having a diameter that will beovergrown by tissue.
 4. The apparatus according to claim 3, wherein thediameter of the holes is smaller than 2.5 mm.
 5. The apparatus accordingto claim 3, wherein the diameter of the holes is smaller than 1.5 mm. 6.The apparatus according to claim 3, wherein the diameter of the holes issmaller than 0.5 mm.
 7. The apparatus according to claim 1, comprising:at least one first connecting tube connected to said fluid movementdevice adapted to drain urine from the urine accumulating renal part ofthe kidney, and—a second connecting tube adapted to be connected to theurine bladder and passing through the wall of said urine bladder,further adapted to be invaginated in the wall of the urine bladder, saidinvaginated part of urine bladder having an outer opening, the first andsecond connecting tubes and the fluid movement device being implantablein the body adapted to move urine from the renal kidney to the urinebladder, using power from said energy source, wherein said secondconnection tube includes said net adapted to seal the tube passagewayout from the the urine bladder, when invaginated by the same, byovergrowth of human tissue in said outer opening.
 8. The apparatusaccording to claim 1, comprising: at least one first connecting tubeconnected to said fluid movement device adapted to drain liquid from thea hydrocephalus in the brain area, and at least one second connectingtube adapted to be connected to the abdomen, the at least one first andsecond connecting tubes and the fluid movement device being adapted tobe implanted inside the body, the fluid movement device further beingadapted to move liquid from the hydrocephalus to the abdomen, usingpower from said energy source.
 9. The apparatus according to claim 1,comprising: at least one first connecting tube connected to said fluidmovement device adapted to drain liquid from ascites in the abdomen, andat least one second connecting tube adapted to be connected to thelymphatic system of the body, the at least one first and secondconnecting tubes and the fluid movement device being adapted to beimplanted inside the body, the fluid movement device further beingadapted to move liquid from the ascites in the abdomen into thelymphatic system, using power from said energy source.
 10. The apparatusaccording to claim 1, comprising: at least one first connecting tubeconnected to said fluid movement device adapted to drain liquid fromascites in the abdomen, and—at least one second connecting tube adaptedto be connected to the urine bladder of the body and passing through thewall of said urine bladder, further adapted to be invaginated in thewall of the urine bladder, said invaginated part of the urine bladderhaving an outer opening, the at least one first and second connectingtubes and the fluid movement device being adapted to be implanted insidethe body, the fluid movement device further being adapted to move liquidfrom the ascites in the abdomen into the urine bladder, using power fromsaid energy source, wherein said second connection tube includes saidnet adapted to seal the tubes passageway out from the the urine bladder,when invaginated by the same, by overgrowth of human tissue in saidouter opening.
 11. The apparatus according to claim 1, comprising: atleast one first connecting tube connected to said fluid movement deviceadapted to drain liquid from the thoraxial cavity, and at least onesecond connecting tube adapted to be connected to the abdomen, the atleast one first and second connecting tubes and the fluid movementdevice being adapted to be implanted inside the body, the fluid movementdevice further being adapted to move liquid from the thorax to theabdomen, using power from said energy source.
 12. The apparatusaccording to claim 1, comprising: a cleaning device.
 13. A device forsecuring a tube through an inner organ of mammal patient, comprising: atube having tube end provided with a net structure secured at a distancefrom the tube end, the tube being adapted to be inserted into an organwith the net structure on the outside.
 14. The device according to claim11, wherein a tube area between the net structure and the organ isadapted to be invaginated in the organ wall.
 15. The apparatus accordingto claim 11, wherein the net structure is sealed around the tube. 16.The apparatus according to claim 11, wherein the net structure isprovided with holes having a diameter that will be overgrown by tissue.17. The apparatus according to claim 14, wherein the diameter of theholes is smaller than 2.5 mm.
 18. The apparatus according to claim 14,wherein the diameter of the holes is smaller than 1.5 mm.
 19. Theapparatus according to claim 19, wherein the diameter of the holes issmaller than 0.5 mm.
 20. A method of securing a connecting tube for usein an implantable device for implantation in human or mammal body,wherein the tube is adapted to move body fluid or hydraulic treatmentfluid from one part of the body, via the at least one connecting tube toanother part of the body, the connecting tube having a distal endadapted to be located in an organ of the human or mammal patient fordrainage of a body fluid or in a reservoir for movement av hydraulictreatment fluid, from a treatment area of the human or mammal patientinto the organ, the method comprising the steps of: opening a hole inthe organ, placing the end of the tube in the organ, securing the tubeon the outside of the organ by invaginating the tube using sutures orstaples, thus creating a tunnel around the tube, wherein said tubecomprising a net material secured to said tube, the further methodcomprising, —placing the net material in connection to the opening ofthe invaginated tunnel, and securing the net material to the outside ofthe organ. 21-22. (canceled)